Primary percutaneous coronary intervention of an unprotected left main using mini‐crush drug‐eluting stents facilitated by intracoronary reteplase

Patients suffering from acute myocardial infarction with involvement of unprotected left main (LM) coronary artery disease represent a very high‐risk subgroup. A 37‐year‐old male patient was admitted with posterolateral acute myocardial infarction and in borderline hemodynamic condition. His left ventricular ejection fraction was 30% with posterior, lateral wall, and apical akinesis along with mild mitral regurgitation. Emergency coronary angiography demonstrated ostial occlusion of the left circumflex artery (without stump, flow Thrombolysis in Myocardial Infarction 0/Rentrop 0) and severe distal LM disease with superimposed thrombus. The primary percutaneous coronary intervention procedure combined intracoronary reteplase plus thrombus aspiration to restore flow in the left circumflex and deployment of two everolimus‐eluting stents with mini‐crush technique to successfully reconstruct the LM bifurcation. The patient recovered without complications and had a favorable outcome at mid‐term.© 2011 Wiley‐Liss, Inc.     

Molecular characterization of Mycobacterium tuberculosis isolates presenting various drug susceptibility from Greece using three DNA typing methods

OBJECTIVES: The purpose of the present study was the molecular characterization of Mycobacterium tuberculosis clinical isolates using three DNA typing methods. METHODS: One hundred nineteen independent (77 susceptible to all antituberculous drugs, 17 rifampin-resistant and 25 isoniazid-resistant), and nine related Mycobacterium tuberculosis isolates obtained over a 3-years period (1997-1999) from Greece were typed with restriction fragment length polymorphism (RFLP), using the non-radioactive IS6110 probe (IS6110-RFLP), and two PCR-based molecular methods: random amplification of polymorphic domains (RAPD) using four different primers and double repetitive element-PCR (DRE-PCR). RESULTS: IS6110-RFLP and RAPD-PCR using IRIS primer were proved to be the most discriminatory methods, while DRE-PCR gave satisfactory results and RAPD-PCR methods using the other three primers (A1245, B1245 and Leg2) were not so effective. The related strains, isolated from affected members of four families, gave similar PCR and RFLP patterns, while the independent strains presented a high degree of polymorphism. In terms of cost effectiveness and technical simplicity, the PCR-based methods were found to be superior. CONCLUSIONS: So, they may serve as screening methods to classify a large number of isolates into clusters for further subtyping and recognition of well-defined genotype families.     

Omeprazole maintenance therapy prevents recurrent ulcer bleeding after surgery for duodenal ulcer

AIM: To evaluate the omeprazole maintenance therapy in patients with recurrent ulcer bleeding after surgery for duodenal ulcer. METHODS: We studied 15 consecutive patients with recurrent ulcer bleeding after surgery for duodenal ulcer. Omeprazole (20 mg/d) maintenance therapy was given after ulcer healing. In addition to clinical follow-up, ambulatory 24-h gastric pH assay was performed before and during omeprazole therapy in those patients and controls with previous duodenal ulcer surgery but no ulcer recurrence. RESULTS: All the 15 ulcers were healed after being treated with omeprazole (40 mg/d) for 2 mo. Eleven patients with two (1-9) episodes of recurrent ulcer bleeding completed the follow-up (43, 12-72 mo). None of them had a bleeding episode while on omeprazole. One patient discontinued the therapy and had recurrent bleeding. The median 24-h fraction time of gastric pH<4 in patients was 80, 46-95%, and was reduced to 32, 13-70% by omeprazole (P=0.002). CONCLUSION: Long-term maintenance therapy with omeprazole (20 mg/day) is effective in preventing recurrent ulcer bleeding.     

Video-capsule endoscopy gastric and small bowel transit time and completeness of the examination in patients with diabetes mellitus

BACKGROUND: Small intestine video-capsule endoscopy examination in patients with diabetes mellitus may be incomplete due to delayed gastric emptying. AIM: To measure video-capsule endoscopy gastric and small bowel transit time and to assess the completeness of the examination in diabetes mellitus patients. METHODS: In this retrospective, case-control study, we examined capsule endoscopy videos from 29 consecutive diabetes mellitus patients. Fifty-eight matched for sex, type of preparation, age and reason for referral non-diabetic controls were selected from our video-capsule endoscopy database. Two independent experienced investigators measured transit times and assessed examinations' completeness. RESULTS: Video-capsule endoscopy gastric transit time was significantly longer in diabetes mellitus (87, 1-478 min) compared to non-diabetic patients (24, 4-108 min, p<0.001). The caecum was visualized in 20/29 (69%) diabetes mellitus and 52/58 (89.6%) non-diabetic controls (p=0.02). In 16 diabetes mellitus patients that video-capsule endoscopy reached the caecum, small bowel transit time was significantly shorter (261.2+/-55.5 min) compared to their 32 non-diabetic matched controls (302+/-62.7 min, p=0.03). CONCLUSIONS: Patients with type 2 diabetes mellitus have prolonged video-capsule endoscopy gastric transit time compared to non-diabetic patients. Prospective studies are required to complete our understanding of video-capsule endoscopy transit times in the setting of diabetes mellitus.     

Endoscopic treatments for chronic radiation proctitis

Chronic radiation proctitis is a complication that occurs in patients who receive radiation therapy for pelvic malignancies. The common presentation is with rectal bleeding, but also rectal pain, diarrhea, tenesmus and even passage of mucus can occur. The optimal treatment of bleeding due to radiation proctitis remains unclear. Among various therapeutic options, medical management is generally ineffective and surgical intervention has a high incidence of morbidity. Promising advances have been made in endoscopic therapy, including argon plasma coagulation (APC), formalin application as well as new techniques such as radio-frequency ablation and cryoablation. APC is a safe, highly effective and long-lasting therapy in patients with rectal bleeding associated with radiation proctitis. It has been shown that several sessions of APC reduce the rate of bleeding and therefore the blood transfusion requirements. Moreover, the effect of treatment is long lasting. However, best results are achieved in patients with mild to moderate radiation proctitis, leaving space for alternative treatments for patients with more severe disease. In patients with severe or refractoryradiation proctitis intra rectal formalin application is an appropriate treatment option. Radiofrequency ablation and cryoablation have shown efficacy as alternative methods in a limited number of patients with refractory chronic radiation proctitis.     

Epigenetics in Gastrointestinal Stromal Tumors: Clinical Implications and Potential Therapeutic Perspectives

Gastrointestinal stromal tumors (GIST) represent the most common mesenchymal neoplasms affecting the gastrointestinal tract. Activating mutations in either the KIT or PDGFRa gene are the principal oncogenic triggers with the former accounting for more than 80 % of cases. In the small subset of GIST that are wild type for both the aforementioned changes, other germline or somatic mutations have been identified. GIST exhibit a highly variable clinical behavior and the main prognostic determinants are tumor size, mitotic rate, and location. It is, however, strongly believed that, beyond classic genetics, additional epigenetic phenomena such as DNA hypomethylation and hypermethylation, microRNA alterations, and chromatin modifications underlie GIST tumorigenesis and influence the clinical course and response to standard treatment. This review aims to illuminate current advances in terms of epigenetics in GIST, as well as possible implications in prognosis and therapeutics.     

A 20‐channel receive‐only mouse array coil for a 3 T clinical MRI system

A 20‐channel phased‐array coil for MRI of mice has been designed, constructed, and validated with bench measurements and high‐resolution accelerated imaging. The technical challenges of designing a small, high density array have been overcome using individual small‐diameter coil elements arranged on a cylinder in a hexagonal overlapping design with adjacent low impedance preamplifiers to further decouple the array elements. Signal‐to‐noise ratio (SNR) and noise amplification in accelerated imaging were simulated and quantitatively evaluated in phantoms and in vivo mouse images. Comparison between the 20‐channel mouse array and a length‐matched quadrature driven small animal birdcage coil showed an SNR increase at the periphery and in the center of the phantom of 3‐ and 1.3‐fold, respectively. Comparison with a shorter but SNR‐optimized birdcage coil (aspect ratio 1:1 and only half mouse coverage) showed an SNR gain of twofold at the edge of the phantom and similar SNR in the center. G‐factor measurements indicate that the coil is well suited to acquire highly accelerated images. Magn Reson Med, 2011. © 2011 Wiley‐Liss, Inc.     

Size‐optimized 32‐channel brain arrays for 3 T pediatric imaging

Size‐optimized 32‐channel receive array coils were developed for five age groups, neonates, 6 months old, 1 year old, 4 years old, and 7 years old, and evaluated for pediatric brain imaging. The array consisted of overlapping circular surface coils laid out on a close‐fitting coil‐former. The two‐section coil former design was obtained from surface contours of aligned three‐dimensional MRI scans of each age group. Signal‐to‐noise ratio and noise amplification for parallel imaging were evaluated and compared to two coils routinely used for pediatric brain imaging; a commercially available 32‐channel adult head coil and a pediatric‐sized birdcage coil. Phantom measurements using the neonate, 6‐month‐old, 1‐year‐old, 4‐year‐old, and 7‐year‐old coils showed signal‐to‐noise ratio increases at all locations within the brain over the comparison coils. Within the brain cortex the five dedicated pediatric arrays increased signal‐to‐noise ratio by up to 3.6‐, 3.0‐, 2.6‐, 2.3‐, and 1.7‐fold, respectively, compared to the 32‐channel adult coil, as well as improved G‐factor maps for accelerated imaging. This study suggests that a size‐tailored approach can provide significant sensitivity gains for accelerated and unaccelerated pediatric brain imaging. Magn Reson Med, 2011. © 2011 Wiley Periodicals, Inc.     

Eight-channel phased array coil and detunable TEM volume coil for 7 T brain imaging.

An eight-channel receive-only brain coil and table-top detunable volume transmit coil were developed and tested at 7 T for human imaging. Optimization of this device required attention to sources of interaction between the array elements, between the transmit and receive coils and minimization of common mode currents on the coaxial cables. Circular receive coils (85 mm dia.) were designed on a flexible former to fit tightly around the head and within a 270-mm diameter TEM transmit volume coil. In the near cortex, the array provided a fivefold increase in SNR compared to a TEM transmit-receive coil, a gain larger than that seen in comparable coils at 3 T. The higher SNR gain is likely due to strong dielectric effects, which cause the volume coil to perform poorly in the cortex compared to centrally. The sensitivity and coverage of the array is demonstrated with high-resolution images of the brain cortex.     

Women athletes with menstrual irregularity have increased musculoskeletal injuries

We have performed a retrospective three-phase study to evaluate the effect of menstrual status upon musculoskeletal injuries in women athletes. Initially, we collected the menstrual and running histories of women participants in a regional 10-km footrace. In this study, 61% of the respondents to our questionnaire reported a continuous running program, and 39% reported an interruption of at least 3 months of their running program. The most common cause for interruption was injury. Those who had interrupted their running were more likely to have had irregular or absent menses and less likely to have been using oral contraceptives than the group of continuous runners. Secondly, we obtained information on the relationship between bone injury and menstrual status by reviewing the sports medicine records of 207 collegiate women athletes. We found that X-ray-documented fractures occurred in 9% of women athletes with regular menses and in 24% of women athletes with irregular or absent menses. Subsequently, we collected data from a larger population of more serious, but still recreational runners, participating in a national 10-km race. Each portion of this study has yielded similar results: those women who had been injured during their running program were more likely to have had absent or irregular menses, were less likely to have used oral contraceptives, and had been running for more years. We conclude that premenopausal women who have absent or irregular menses, while engaged in vigorous exercise programs, are at increased risk for musculoskeletal injury.